Patients Want More Control Over Their Health Care
The rapid advance of medical science over the past century means patients now have more therapies available to them than ever before. Historically, patients relied on physicians to provide them with information about medical developments.
With the arrival of managed care in the 1970s, physicians have seen their caseloads rise. According to an article in the May 2004 Journal of the American Medical Association, physicians spend less than one minute discussing treatment during a 20-minute office visit, on average. About half the time, doctors fail to ask patients whether they have any questions about what has been discussed during the visit.
As doctors become more hurried, they have less time for patient education. Patients are finding it increasingly necessary to take matters into their own hands.
Patients Can Find Information
The Internet gives patients a powerful new tool with which to educate themselves and manage their health care needs. Many Web sites provide clinical information and resources directly to patients. These include sites dedicated to providing information on treatment alternatives, clinical trials, and prescription drugs, as well as resources for patients afflicted with specific diseases.
A few hours on the Internet can substitute for a face-to-face education that would be costly for a patient. Recent reports, including a January 26, 2004, article in American Medical News, suggest it may actually save the doctor valuable time when patients inform themselves before an office visit.
Another trend that may explain consumers' interest in health information is the rise of consumer-driven health care plans. The heath insurance company Aetna, for example, found enrollees in its health reimbursement arrangement (called HealthFund) were more likely to use the Internet to manage their own care. A February 2004 study found HealthFund enrollees used HealthWise (an Internet health information Web service) twice as often as the control group, and the health information Web site InteliHealth 48 percent more often. HealthFund enrollees also searched formularies for drug price information almost twice as often as the control group.
Patients Can Test Selves
Many firms now offer medical tests patients can order themselves; they pay their fee online and stop by a collection point to drop off their specimen. HS Labs (http://www.BloodWorksUSA.com), for example, offers "Complete Blood Work Special Tests" for about $95. Direct Laboratory Services, Inc. (http://www.DirectLabs.com) offers a similar blood profile, based on more than 50 individual tests, for $89.
Sales data show a growing trend toward over-the-counter purchases of self-diagnostic tests. From 1992 through 2002, sales nearly quadrupled, to $2.8 billion per year.
Home pregnancy tests are so common they are sold in pharmacies, grocery stores, and even inexpensive dollar stores. Ovulation predictor tests and tests for menopause, cholesterol, and other conditions also are widely available.
For about $50, parents can buy an EarCheck Middle Ear Monitor that uses sonar to check for fluid behind the eardrum, which may indicate an ear infection. One of the most common reasons kids see a doctor, ear infections account for 20 million office visits annually in the United States.
Likewise, kids often develop sore throats that don't require a physician visit. Families can buy a QuickVue Strep Test for about $90, providing 25 tests. The simple test differentiates strep infections, which require a physician visit, from viral infections, which do not.
Patients Can Treat Selves
Why do patients value having more knowledge about what ails them without having to run to the doctor's office? Probably so they can make better decisions about which symptoms require consultations and which they can treat themselves.
According to a March 2000 article in the British Medical Journal, only one of every 40 symptoms actually results in a patient seeking an office visit for a medical consultation.
For example, it has been estimated that between 15 and 40 percent of the general population experiences gastrointestinal symptoms such as rectal bleeding, irritable bowel syndrome, and dyspepsia (i.e. chronic indigestion). Yet only one-quarter to one-third of the people experiencing these symptoms ever consult a practitioner.
When patients do see physicians, it is often for conditions they could easily have treated themselves. In the September 2003 issue of Employee Benefits Journal, benefits experts report up to 25 percent of physician visits may fall into that category. And according to the November 2001 issue of Occupational Health Management, 55 percent of the 103 million visits to the emergency department of U.S. hospitals in 1999 were unnecessary. Even annual physicals may be of little value. (See "Annual Physical Checkup May Be an Empty Ritual," New York Times, August 12, 2003.)
Patients Can Self-Prescribe
One of the primary reasons patients schedule office visits is for access to prescription drugs. Two-thirds of office visits to physicians result in prescription drug therapy.
About 80 percent of the time, patients facing medical symptoms turn first to over-the-counter (OTC) drugs for treatment. OTC drugs account for 60 percent of drugs used by Americans. If patients sought professional care in only 2 percent of these cases, rather than self-treatment, the increase in office calls would require a 50 percent increase in the number of primary care physicians.
The Food and Drug Administration (FDA) has recently shown a greater willingness to switch many formerly prescription-only drugs to OTC status, authorizing such status for the allergy medicine Claritin in 2002 and the anti-ulcer drug Prilosec in 2003.
Unfortunately, in January consumers lost an opportunity to take charge of an important aspect of their medical care when an FDA advisory panel voted against OTC access to the cholesterol-reducer Mevacor.
Consumers Can Take Control
Consumers are seeking ways to exercise more control over their medical care decisions. This may be through "informed decision-making," when patients discuss treatments with their physician, or it may be through enlightened "self care," with patients diagnosing their own conditions and making decisions about treatments.
Some observers believe self-treatment based on information obtained from the Internet is not in the best interests of patients. Nonetheless, growing numbers of patients prefer to treat what they can at home, and make decisions jointly with their doctors for those therapies available only by prescription.
Devon M. Herrick, Ph.D. (firstname.lastname@example.org) is a senior fellow at the National Center for Policy Analysis.